Patient engagement in forensic mental health care: a scoping review

This scoping review aimed to examine the state of research on patient engagement in forensic mental health (FMH) care to inform future research, practice and policy development.

A systematic literature search was conducted in Medline, Embase, CINHAL, PsycINFO and EBSCO from database inception to June 2024, supplemented by grey literature and reviews. We analysed the included studies descriptively and narratively.

Of the 7010 records retrieved, 73 studies were included. Research on patient engagement in FMH has increased since 1999, with all studies conducted in high-income countries and the majority (64%) employing qualitative designs. The focus was primarily on risk assessment and management, recovery and therapeutic or medication interventions. Most patient participants were male, white and diagnosed with schizophrenia, personality disorders or substance use disorders. Nurses were the major staff participants. The levels of engagement were typically involvement and collaboration. Commonly reported outcomes were a sense of engagement and risks of violence and aggression. We identified barriers and potential strategies for patient engagement across five levels: patient, staff, process, organisational and sociopolitical. Barriers to patient engagement included, but were not limited to, patients' mental health conditions, paternalistic staff attitudes and power imbalances. Potential strategies to enhance patient engagement were identified, such as the adoption of recovery-oriented care models.

Patient engagement in FMH is hindered by multilevel barriers, requiring coordinated efforts from policymakers, organisational leaders, professionals and patients to facilitate its integration into routine practice. Greater attention is needed to ensure the meaningful engagement of marginalised populations and patients from low and middle-income countries.